Effect of opioid-free versus opioid-based strategies during multimodal anaesthesia on postoperative morphine consumption after bariatric surgery : a randomised double-blind clinical trial
© 2024 The Author(s)..
Background: The efficacy and safety of opioid-free anaesthesia during bariatric surgery remain debated, particularly when administering multimodal analgesia. As multimodal analgesia has become the standard of care in many centres, we aimed to determine if such a strategy coupled with either dexmedetomidine (opioid-free anaesthesia) or remifentanil with a morphine transition (opioid-based anaesthesia), would reduce postoperative morphine requirements and opioid-related adverse events.
Methods: In this prospective double-blind study, 172 class III obese patients having laparoscopic gastric bypass surgery were randomly allocated to receive either sevoflurane-dexmedetomidine anaesthesia with a continuous infusion of lidocaine and ketamine (opioid-free group) or sevoflurane-remifentanil anaesthesia with a morphine transition (opioid-based group). Both groups received at anaesthesia induction a bolus of magnesium, lidocaine, ketamine, paracetamol, diclofenac, and dexamethasone. The primary outcome was 24-h postoperative morphine consumption. Secondary outcomes included postoperative quality of recovery (QoR40), incidence of hypoxaemia, bradycardia, and postoperative nausea and vomiting (PONV).
Results: Eighty-six patients were recruited in each group (predominantly women, 70% had obstructive sleep apnoea). There was no significant difference in postoperative morphine consumption (median [inter-quartile range]: 16 [13-26] vs 15 [10-24] mg, P=0.183). The QoR40 up to postoperative day 30 did not differ between groups, but PONV was less frequent in the opioid-free group (37% vs 59%, P=0.005). Hypoxaemia and bradycardia were not different between groups.
Conclusions: During bariatric surgery, a multimodal opioid-free anaesthesia technique did not decrease postoperative morphine consumption when compared with a multimodal opioid-based strategy. Quality of recovery did not differ between groups although the incidence of PONV was less in the opioid-free group.
Clinical trial registration: NCT05004519.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:9 |
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| Enthalten in: |
BJA open - 9(2024) vom: 27. März, Seite 100263 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Clanet, Matthieu [VerfasserIn] |
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| Links: |
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| Themen: |
Dexmedetomidine |
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| Anmerkungen: |
Date Revised 05.03.2024 published: Electronic-eCollection ClinicalTrials.gov: NCT05004519 Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.bjao.2024.100263 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369256824 |
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| 100 | 1 | |a Clanet, Matthieu |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effect of opioid-free versus opioid-based strategies during multimodal anaesthesia on postoperative morphine consumption after bariatric surgery |b a randomised double-blind clinical trial |
| 264 | 1 | |c 2024 | |
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| 500 | |a published: Electronic-eCollection | ||
| 500 | |a ClinicalTrials.gov: NCT05004519 | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2024 The Author(s). | ||
| 520 | |a Background: The efficacy and safety of opioid-free anaesthesia during bariatric surgery remain debated, particularly when administering multimodal analgesia. As multimodal analgesia has become the standard of care in many centres, we aimed to determine if such a strategy coupled with either dexmedetomidine (opioid-free anaesthesia) or remifentanil with a morphine transition (opioid-based anaesthesia), would reduce postoperative morphine requirements and opioid-related adverse events | ||
| 520 | |a Methods: In this prospective double-blind study, 172 class III obese patients having laparoscopic gastric bypass surgery were randomly allocated to receive either sevoflurane-dexmedetomidine anaesthesia with a continuous infusion of lidocaine and ketamine (opioid-free group) or sevoflurane-remifentanil anaesthesia with a morphine transition (opioid-based group). Both groups received at anaesthesia induction a bolus of magnesium, lidocaine, ketamine, paracetamol, diclofenac, and dexamethasone. The primary outcome was 24-h postoperative morphine consumption. Secondary outcomes included postoperative quality of recovery (QoR40), incidence of hypoxaemia, bradycardia, and postoperative nausea and vomiting (PONV) | ||
| 520 | |a Results: Eighty-six patients were recruited in each group (predominantly women, 70% had obstructive sleep apnoea). There was no significant difference in postoperative morphine consumption (median [inter-quartile range]: 16 [13-26] vs 15 [10-24] mg, P=0.183). The QoR40 up to postoperative day 30 did not differ between groups, but PONV was less frequent in the opioid-free group (37% vs 59%, P=0.005). Hypoxaemia and bradycardia were not different between groups | ||
| 520 | |a Conclusions: During bariatric surgery, a multimodal opioid-free anaesthesia technique did not decrease postoperative morphine consumption when compared with a multimodal opioid-based strategy. Quality of recovery did not differ between groups although the incidence of PONV was less in the opioid-free group | ||
| 520 | |a Clinical trial registration: NCT05004519 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a dexmedetomidine | |
| 650 | 4 | |a enhanced recovery after surgery | |
| 650 | 4 | |a hypoxaemia | |
| 650 | 4 | |a nausea | |
| 650 | 4 | |a nociception | |
| 650 | 4 | |a pain | |
| 650 | 4 | |a remifentanil | |
| 650 | 4 | |a vomiting | |
| 700 | 1 | |a Touihri, Karim |e verfasserin |4 aut | |
| 700 | 1 | |a El Haddad, Celine |e verfasserin |4 aut | |
| 700 | 1 | |a Goldsztejn, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Himpens, Jacques |e verfasserin |4 aut | |
| 700 | 1 | |a Fils, Jean Francois |e verfasserin |4 aut | |
| 700 | 1 | |a Gricourt, Yann |e verfasserin |4 aut | |
| 700 | 1 | |a Van der Linden, Philippe |e verfasserin |4 aut | |
| 700 | 1 | |a Coeckelenbergh, Sean |e verfasserin |4 aut | |
| 700 | 1 | |a Joosten, Alexandre |e verfasserin |4 aut | |
| 700 | 1 | |a Dandrifosse, Anne-Catherine |e verfasserin |4 aut | |
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